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  #41  
Old 06-12-2009, 12:09 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by claymisher View Post
Megan (at least in this one) is a one-way function. It only takes her a second to spout nonsense, but it takes poor Mark Schmitt minutes to spell out why she's wrong. Hell of a debating tactic.
Over on the Prospect's blog TAPPED Mark Schmitt it explains it better:
Quote:
You may be familiar with a wonderful short book by the economist/philosopher Albert O. Hirschman called The Rhetoric of Reaction. Hirschman (better known for his essay "Exit, Voice and Loyalty") simply catalogs the three great arguments that conservatives use against virtually any progressive idea: Perversity (It will do the opposite of what you intend). Futility (It'll never work). And Jeopardy (It'll cost too much).

The book is only 167 pages long, but if you were hoping for a movie version, may I recommend bloggingheads today, where Megan McArdle of The Atlantic and I started off talking about the budget deficit, and quickly moved on to health reform, which I think is key to solving the long-term budget problem, and Megan, well, Megan thinks it will never work, will do the opposite of what's intended ("it will kill thousands of people"), and will cost too much. You can decide for yourself.
Heheheh.
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  #42  
Old 06-12-2009, 12:33 PM
gwlaw99 gwlaw99 is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by AemJeff View Post
Drug companies waste a lot of resources on reinventing Vioxx, or creating a new Statin, or whatever - or worse yet, finding a tiny tweak in a molecule so they can market an extremely similar variant on an older drug under a a new patent, extending their monopoly for another seventeen years..
Speaking as someone who had to try four variants of same type of drug to get one to actually work (some actually made my medical condition worse), I believe that things like "creating a new statin" are very beneficial and not just marketing. Also remember that statins were once completely new drugs that required billions in research to develop. With price controls, they may not have been profitable enough to develop in the first place.

Quote:
Speaking as somebody who is deeply deeply dependent on pharmaceuticals - of me twelve daily prescriptions, two are not generic, and one of the non-generics is insulin, which isn't available in generic form. Where is all the innovation, when out of all those drugs, only one is actually recent enough to covered by a patent?..
I don't really get what you are complaining about. 10/12 of your prescriptions are available cheaply as generic. How is this bad? Generic insulin production is banned by US law against generic biologics. Granted a change in the law is opposed by Pharm companies, but there are good arguments for and against allowing generic biologics.

http://drugtopics.modernmedicine.com....jsp?id=417490

Quote:
I don't believe that the actual needs of the people for whom pharmaceuticals could be helpful are particularly well aligned with the interests of the producers of pharmaceuticals.
Can you explain your reasoning for this conclusion more fully?


Quote:
If the system gets shaken up a bit, if the formula governing where from, and how much, and howe to allocate R&D dollars were changed significantly - I don't believe my interests are likely to be damaged, and I think of myself as a pretty representative member of the the class of people who benefit from the output of the pharma industry.
What kind of changes are you proposing?

I also don't think you addressed my major point that innovation for completely new drugs for fighting cancer (8 million deaths per year world wide), heart disease (16.7 million deaths per year workd wide), etc. would be completely stifled by price controls as there would be no economic incentive to develop such drugs. making improvements to existing drugs would be much more profitable. Although this type of research does have benefits as I argued above, truely innovative research will be crowded out.

2006 and 2007 were the first time cancer deaths per year have ever dropped in the US. Could this have ever been done without billions of dollars of research by Pharma companies?
http://www.sciencedaily.com/releases...0118095233.htm

Last edited by gwlaw99; 06-12-2009 at 12:44 PM..
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  #43  
Old 06-12-2009, 12:54 PM
Lyle
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

I agree with you about Megan.
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  #44  
Old 06-12-2009, 01:15 PM
DoctorMoney DoctorMoney is offline
 
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Default Re: Megan's flawed utilitarian analysis

Quote:
Originally Posted by pampl View Post
Your premise - that medical innovation doesn't "trickle down" - is wrong. One obvious example, out of many, is new AIDS drugs.
The problem is that care isn't about innovation. If you want to argue that the government shouldn't tax pharmaceutical companies at all to spur innovation, you might make some headway.

But you can't lump pharma and health care providers together as if their financial incentives are at all the same. It's like saying that we'll get better TV programming if we tax Samsung at a lower rate.

Health care access is a delivery system and drug research is content. We don't have a content problem in the US, we have an access problem. So every moment we sit here talking about innovation is one in which we are not discussing our actual problems.

Last edited by DoctorMoney; 06-12-2009 at 01:22 PM..
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  #45  
Old 06-12-2009, 01:16 PM
holyworrier holyworrier is offline
 
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Default Re: Megan's flawed utilitarian analysis

Quote:
Originally Posted by pampl View Post
Try actually reading the article you linked to. You're simply wrong.
MM prefaced her remarks on the market and innovation in terms of utilitarian argument. The market, according to her, creates greater good for a greater number. Am I wrong about her meaning? Three hundred million people in the US who will die of diseases we have no cure for, I think she said, and this number is far more than the number who will die for lack of health care. Therefore innovating for those many millions is more important than providing health basics for the fewer millions. Am I on the mark so far? Do you consider that her remarks properly reflect your interpretation of a utilitarian argument? Or do they reflect what I call the 'common understanding' of the nature of utilitarian theory? I interpreted them as the latter.

All I'm trying to do is take the sense of her usage of 'utilitarian' and show that her argument is flawed. I sensed I might get called on the complexities of all the variants of the philosophy, of which I am aware. I've read several papers on dense utilitarian problems. I don't care about that here. I'm taking MM's statement and dealing with it in the sense that it was made.

I made no reference to increasing equality. What I referred to was decreasing suffering for a greater number. Is that not a tenet of utilitarianism?

MM's and your reference to the plight of the world's poor is touching, but irrelevant, tangential, to a discussion of the flaws in the American health care system. And so what if the poor in America are better off than the poor in Bengal. They don't live in Bengal. If they did, they'd occupy the same social tier they occupy in the US, which is the bottom one. The poor in both places die prematurely. A discussion of the relative wealth of the poor in different countries is a pointless, masturbatory affair.

Does MM, or do you mean to imply that because a company can only make, say, 12% profit, that they will throw up their hands and say 'if I can't make 18%, this whole thing is just not worth the effort!' If higher profits mean greater innovation, why not encourage the pharmaceutical and technology companies to charge double what they get now? Wouldn't that benefit the world even more?
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  #46  
Old 06-12-2009, 01:20 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

I think I caught McArdle doing the great libertarian cop-out: the people in poor countries are worse off than America's poor, so let's help neither.

Will Wilkinson plays that one all the time.

Last edited by claymisher; 06-12-2009 at 01:58 PM..
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  #47  
Old 06-12-2009, 01:39 PM
pampl pampl is offline
 
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Default Re: Megan's flawed utilitarian analysis

Quote:
Originally Posted by holyworrier View Post
MM prefaced her remarks on the market and innovation in terms of utilitarian argument. The market, according to her, creates greater good for a greater number. Am I wrong about her meaning? Three hundred million people in the US who will die of diseases we have no cure for, I think she said, and this number is far more than the number who will die for lack of health care. Therefore innovating for those many millions is more important than providing health basics for the fewer millions. Am I on the mark so far? Do you consider that her remarks properly reflect your interpretation of a utilitarian argument? Or do they reflect what I call the 'common understanding' of the nature of utilitarian theory? I interpreted them as the latter.

All I'm trying to do is take the sense of her usage of 'utilitarian' and show that her argument is flawed. I sensed I might get called on the complexities of all the variants of the philosophy, of which I am aware. I've read several papers on dense utilitarian problems. I don't care about that here. I'm taking MM's statement and dealing with it in the sense that it was made.

I made no reference to increasing equality. What I referred to was decreasing suffering for a greater number. Is that not a tenet of utilitarianism?
I agree that it reflects your understanding. I think it reflects mine as well. You did repeatedly make reference to increasing equality. Your exact words were that instead of "compounding advantage" it should "decrease disparity". That was your justification for it being utilitarian, which of course is a complete non-sequitor. We could decrease disparity by killing Bill Gates and throwing his money out at a big parade, it doesn't follow that it'll increase net happiness or decrease net spending.
Quote:
MM's and your reference to the plight of the world's poor is touching, but irrelevant, tangential, to a discussion of the flaws in the American health care system. And so what if the poor in America are better off than the poor in Bengal. They don't live in Bengal. If they did, they'd occupy the same social tier they occupy in the US, which is the bottom one. The poor in both places die prematurely. A discussion of the relative wealth of the poor in different countries is a pointless, masturbatory affair.

Does MM, or do you mean to imply that because a company can only make, say, 12% profit, that they will throw up their hands and say 'if I can't make 18%, this whole thing is just not worth the effort!' If higher profits mean greater innovation, why not encourage the pharmaceutical and technology companies to charge double what they get now? Wouldn't that benefit the world even more?
It's neither irrelevant nor tangential. If the US system as it currently stands is subsidizing health research that benefits the rest of the world, then you can't really just say the rest of the world is subhuman and not worth moral consideration. It's like advocating the US switch to all coal power and waving away any environmental complaints because those will effect the rest of the world and we're just talking about the US's energy policy.

There are things in the world that are non-linear. For instance, if I drank one Coke now, I would be happy. If I had 5 Cokes, I'd actually be unhappy, not 5x as happy.
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  #48  
Old 06-12-2009, 02:12 PM
claymisher claymisher is offline
 
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Default Lilly Sold Drug for Dementia Knowing It Didnít Help, Files Show

From today's headlines:
Quote:
June 12 (Bloomberg) -- Eli Lilly & Co. urged doctors to prescribe Zyprexa for elderly patients with dementia, an unapproved use for the antipsychotic, even though the drugmaker had evidence the medicine didnít work for such patients, according to unsealed internal company documents.

In 1999, four years after Lilly sent study results to the U.S. Food and Drug Administration showing Zyprexa didnít alleviate dementia symptoms in older patients, it began marketing the drug to those very people, according to documents unsealed in insurer suits against the company for overpayment.
http://www.bloomberg.com/apps/news?p...d=aTLcF3zT1Pdo
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  #49  
Old 06-12-2009, 02:48 PM
AemJeff AemJeff is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by gwlaw99 View Post
Speaking as someone who had to try four variants of same type of drug to get one to actually work (some actually made my medical condition worse), I believe that things like "creating a new statin" are very beneficial and not just marketing. Also remember that statins were once completely new drugs that required billions in research to develop. With price controls, they may not have been profitable enough to develop in the first place.



I don't really get what you are complaining about. 10/12 of your prescriptions are available cheaply as generic. How is this bad? Generic insulin production is banned by US law against generic biologics. Granted a change in the law is opposed by Pharm companies, but there are good arguments for and against allowing generic biologics.

http://drugtopics.modernmedicine.com....jsp?id=417490



Can you explain your reasoning for this conclusion more fully?




What kind of changes are you proposing?

I also don't think you addressed my major point that innovation for completely new drugs for fighting cancer (8 million deaths per year world wide), heart disease (16.7 million deaths per year workd wide), etc. would be completely stifled by price controls as there would be no economic incentive to develop such drugs. making improvements to existing drugs would be much more profitable. Although this type of research does have benefits as I argued above, truely innovative research will be crowded out.

2006 and 2007 were the first time cancer deaths per year have ever dropped in the US. Could this have ever been done without billions of dollars of research by Pharma companies?
http://www.sciencedaily.com/releases...0118095233.htm
I'm not arguing that pharma ought not be creating variants of various drugs, and trying to improve them. Clearly this is a big part of the mission. What I am saying is that a lot of the R&D money that inevitably becomes the focus of this sort of conversation is not spent on "innovation" and that the argument that the bulk of pharma profit is spent developing great new medications is simply false. Most of their effort is geared toward recreating past successes and incremental improvement to current art.

I'm personally quite aware of the improvements in cancer therapies, having seen several people survive far longer than it used to be that anyone had any right to expect. Do they need to charge tens and hundreds of thousands of dollars annually for newer therapies? Would there be no financial incentive to create such therapies if the cost to patients wasn't multiples of most people's annual income? I doubt it.

And, I'm perfectly happy that my medications are mostly generic. The argument is that the touted "innovation" isn't evident, when most medications that people actually take have been on the market long enough such that their patents have expired.

Pharmaceutical companies have every right to earn a profit. I shouldn't have to make that explicit. The arguments used to counter the idea that the current financial model under which they operate isn't necessarily optimal, are always over the top prediction of disaster if anything at all is changed. I see no reason to believe that's true. I don't believe that industrial market forces have any reasonable correlation with actual patient needs and I support as much regulation of the industry as it takes to create a set of forces that will help to align those things.
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  #50  
Old 06-12-2009, 03:01 PM
yamascuma yamascuma is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Megan, your behavior during this diavlog was outrageous. I hope you have a chance to watch it and that you are shocked and embarrassed by how rude you were to Mark and how unfair many of your arguments were. If your only response to Mark's suggestion of "changing the culture" at hospitals is to snap about REEDUCATION CAMPS, you need to do a bit more reading, maybe some meditation, and check back again in a year. (I'm not an expert, but how about granting bonuses and payment based on health outcomes, rather than procedures?) You complained that Mark sounded like an 1890s-style socialist pamphlet, but you sounded like a McCarthy-era red-baiter. I'm pretty sure that's beneath you, and it's definitely beneath bloggingheads.

Furthermore, I've lived in McAllen Texas, Megan, and you don't know McAllen Texas. It's not a place that young doctors want to go live - it's a place that almost no one wants to go live. It is one of the poorest counties in the country and one of the cheapest places to live. If you made $85,000 a year you could live like a prince. Hell, you can live pretty well on $25,000 down there. The only reason for people not born there to move there is economic opportunity. Perhaps there was an interesting conversation to be had about how to get doctors to go to places that they _don't_ want to live without extraordinary compensation. But your idea about doctors wanting to live there and thus creating their own demand seems about 180 degrees backwards. McAllen is not a place where doctors want to go live, and is full of incredibly unhealthy people - rates of obesity and diabetes are off the charts, for example.

Also, when Mark said that the government created the culture as it is, and Megan said "it just happened" Mark was right. The same thing is true of capitalism in general, which doesn't come into being without government intervention. C.f. Karl Polanyi, The Great Transformation.

Ugh.

Here's the dingalink to this shameful mess:
http://bloggingheads.tv/diavlogs/203...4:38&out=48:10
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  #51  
Old 06-12-2009, 03:10 PM
TallDave TallDave is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

"there are very many people in this country who are incapable of procuring necessary health care when they desperately need it because of their financial and employment situation. "

Virtually everyone not here illegally has access to Medicaid programs.

We're not talking about universal health care, we're talking about universal welfare.
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  #52  
Old 06-12-2009, 03:15 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by TallDave View Post
"there are very many people in this country who are incapable of procuring necessary health care when they desperately need it because of their financial and employment situation. "

Virtually everyone not here illegally has access to Medicaid programs.

We're not talking about universal health care, we're talking about universal welfare.
What are the eligibility requirements for Medicaid?
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  #53  
Old 06-12-2009, 03:16 PM
AemJeff AemJeff is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Originally Posted by TallDave View Post
"there are very many people in this country who are incapable of procuring necessary health care when they desperately need it because of their financial and employment situation. "

Virtually everyone not here illegally has access to Medicaid programs.

We're not talking about universal health care, we're talking about universal welfare.
Try getting regular treatment for a chronic ailment when you're uninsured. Try getting insured if you have a chronic ailment when you don't have an employer willing or able to provide it. I really don't know what you're talking about.
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  #54  
Old 06-12-2009, 03:18 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Originally Posted by yamascuma View Post
Also, when Mark said that the government created the culture as it is, and Megan said "it just happened" Mark was right. The same thing is true of capitalism in general, which doesn't come into being without government intervention. C.f. Karl Polanyi, The Great Transformation.
Well put.

BTW, how did you come across "The Great Transformation"? I've been interested in economics and anthropology (majored in both in college) for 20 years, and I only just came across it this year. Now all of a sudden I see it cited everywhere!
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  #55  
Old 06-12-2009, 03:20 PM
TallDave TallDave is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

"Try getting regular treatment for a chronic ailment when you're uninsured. "

You don't think Medicaid covers chronic ailments?
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  #56  
Old 06-12-2009, 03:22 PM
TallDave TallDave is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

They're administered by the states, so vary from state to state, but generally you just need to prove you are a U.S. citizen and can't pay for it.
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  #57  
Old 06-12-2009, 03:22 PM
AemJeff AemJeff is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Originally Posted by TallDave View Post
"Try getting regular treatment for a chronic ailment when you're uninsured. "

You don't think Medicaid covers chronic ailments?
If you're eligible. I wasn't when I needed it.
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  #58  
Old 06-12-2009, 03:23 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by TallDave View Post
They're administered by the states, so vary from state to state, but generally you just need to prove you are a U.S. citizen and can't pay for it.
What's the eligibility requirement in your state?
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  #59  
Old 06-12-2009, 03:38 PM
Jyminee Jyminee is offline
 
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Default Question for Megan re: NY

Here Megan claims New York in an awful place for businesses to operate, one of the bottom three in the country.

If this is true, why do thousands of companies--including some of the country's largest--inhabit the island of Manhattan? New Jersey is right across the river, and Connecticut isn't too far away either. All of these are knowledge-based businesses that could easily relocate. If NY is so horrible, why don't they move?
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  #60  
Old 06-12-2009, 03:44 PM
Terrye Terrye is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

I have to wonder what libertarians who voted for Obama thought they were going to get. Of course Obama is going to nationalize health care if he can.

I work in health care. It is not true that people die in this country because they can not afford health care. That is a myth. It is also not true that people with chronic conditions can not get care. I know a lot of people on medicaid who get all of their care and meds without charge. I know veterans who get care without charge. That is already available to people.

Here in Indiana the state government created a program designed to help people get coverage and many of the people who could have gotten help did not want to even bother with the paperwork necessary to get it. A lot of the people who do not have health insurance, do not want it. The only way a program will provide all these people with care is if it is mandatory like car insurance.

And I really do not think people are interested in something like that. The problem with health care is the cost of it, not the availability. Nothing is free. Not really.
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  #61  
Old 06-12-2009, 04:05 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by Terrye View Post
I work in health care. It is not true that people die in this country because they can not afford health care. That is a myth. It is also not true that people with chronic conditions can not get care. I know a lot of people on medicaid who get all of their care and meds without charge. I know veterans who get care without charge. That is already available to people.
The only way you're going to convince somebody that the undertreated poor don't really exist is if you loan them your ideological blinders.

You also haven't been following politics very closely either. Obama has never endorsed single-payer. He's explained frequently why it's not worth the fight. Hell, there aren't even 60 votes in the Senate for the public option.

Here's a tip: don't make up stuff. People will call you on it.
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  #62  
Old 06-12-2009, 04:41 PM
conncarroll conncarroll is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

My favorite part was when Mark explained that liberalism's entire health care (and therefore deficit reduction) plan rested on Peter Orszag finding the "Holy Grail" of controlling health care costs.
As Bill Simmons would ask "where can I buy stock in Orszag completely failing to lower the deficit?"
Oh wait, I can!
http://www.ft.com/cms/s/0/68ca2d04-5...44feabdc0.html
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  #63  
Old 06-12-2009, 05:06 PM
Terrye Terrye is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

claymisher:

Make stuff up? I work for a home health care agency. I have clients who get home health care aid visits, their meds, counseling and phsyical ed through the state. This is what I do.

I did not say there were no poor people, I said people were not dying because they are poor and can not get care.
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  #64  
Old 06-12-2009, 05:14 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Quote:
Originally Posted by Terrye View Post
claymisher:

Make stuff up? I work for a home health care agency. I have clients who get home health care aid visits, their meds, counseling and phsyical ed through the state. This is what I do.

I did not say there were no poor people, I said people were not dying because they are poor and can not get care.
Let me get this straight, because you see poor folks getting care (and good for you too, btw), that means there are no poor folks not getting care. I'm not an expert at logic but I'm pretty sure there's a flaw in that.
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  #65  
Old 06-12-2009, 05:15 PM
geoffrobinson geoffrobinson is offline
 
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Default No Tort Reform

Everyone is missing the one thing which will mess this all up. The Dems won't enact meaningful tort reform. All of the preventative medicine that gets done to prevent lawsuits probably runs several billion dollars. Now, doctors will get sued on one end and shafted by the government on the other.
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  #66  
Old 06-12-2009, 05:16 PM
Terrye Terrye is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

As far as Obama endorsing a single payer system, I think it is Obama's intent to nationalize health care whatever he might say.
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  #67  
Old 06-12-2009, 05:32 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Originally Posted by Terrye View Post
As far as Obama endorsing a single payer system, I think it is Obama's intent to nationalize health care whatever he might say.
What, you can read minds? For the non-mind-readers out there, here's Obama saying why he's not pushing for single-payer, let alone nationalization:

Quote:
Q Good afternoon, Mr. President. I am Paulette Garren (phonetic). As a self-employed individual, I spend approximately $8,000 annually on my health insurance premium, and it's a $2,000 deductible -- no dental, no vision, no prescription coverage. As my business is declining because of the economy we have, I am now in a situation where I'm taking savings to help pay for food and housing, because I also still don't want to lose my health insurance. And I will be frank and honest with you: I am a supporter of a single-payer system over any other system, because I do -- (applause) -- thank you -- I do believe that it will meet your three criteria and be the most economically feasible plan that we have.

When you were speaking, you mentioned that if we go with a public and a private option, that the public option will keep the private insurers honest. My concern is that we will end up in a situation like we have with Medicare, where Medicare is basically a subsidy of private insurance companies, because folks are able to buy Medicare Advantage. It seems to me that we would take that same scenario and increase it outward for the entire country. And that is why I still support single payer, and I know that at one point you did. And I would ask that it still be on the table for consideration, and thank you so much for your time. (Applause.)

PRESIDENT OBAMA: Thank you for the great question.

Let me just talk about some of the different options that are out there, because sometimes there's been confusion in the press and the public, and people use, you know, politics in talking about the issue. There are some folks who say, "socialized medicine." You hear that all the time, "socialized medicine." Well, socialized medicine would mean that the government would basically run all of health care. They would hire the doctors, they would run the hospitals. They would just run the whole thing. Great Britain has a system of socialized medicine.

Nobody is talking about doing that, all right? So when you hear people saying, "socialized medicine," understand I don't know anybody in Washington who is proposing that, certainly not me.

Socialized medicine is different from a single-payer plan. Now, the way a single-payer plan works is that you still have private doctors, private hospitals, providers, et cetera, but everything is reimbursed through a single payer; usually, the government. So Medicare would be an example of a single-payer plan. Doctors don't work for Medicare, but Medicare reimburses for services that are provided to seniors who are on Medicare.

There have been proposals to have, essentially, Medicare for all, a single-payer plan for all Americans, and -- that person likes it. (Laughter.) And there are some appealing things to a single-payer plan, and there are some countries where that's worked very well.

Here is the thing: We're not starting from scratch. We've already got -- because of all kinds of historical reasons, we have primarily an employer-based system that uses private insurers alongside a Medicare plan for people above a certain age; and then you've got Medicaid for folks who are very poor and don't have access to health care. So we've got sort of a patchwork system. And it was my belief and continues to be my belief that whatever we might do if we were just starting from scratch, that it was important in order to get it done politically, but also to minimize disruptions to families that we start with what we have, as opposed to try to completely scrap the system and start all over again.

And so what my attitude was if you've got an employer-based system -- and a lot of people still get their health insurance through their jobs -- obviously, you're self-employed, so there's a different category, but the majority of people still get their health insurance through their employer. Rather than completely disrupt things for them, my attitude is let them keep the health insurance that they've got, the doctors that they have -- there's still a role for private insurance -- but number one, let's have insurance reform so that you can't eliminate people for preexisting conditions -- (applause) -- so that there's none of the cherry picking that's going on to try to just get the healthiest people insured and get rid of the sick people. So you've got to set up some rules for how insurance companies operate.

Number two, that for people who are self-employed, for small businesses, for others, they should have an option that they can go to if they can't get insurance through the private marketplace. That's why I've said that I think a public option would make sense. What that then does is it gives people a choice. If they're happy with what they've got, if they're employed by somebody who provides them with good health care, you can keep it, you don't have to do anything. But if you don't have health insurance, then you have an option available to you.

Now, how this debate is evolving in Washington, unfortunately sometimes kind of falls into the usual politic. So what you've heard is some folks on the other side saying, "I'm opposed to a public option because that's going to lead to government running your health care system." Now, I don't know how clearly I can say this, but let me try to repeat it: If you've got health insurance that you're happy with through the private sector, then we're not going to force you to do anything. All we're saying is for the 46 million people who don't have health insurance, or for people who've got health insurance, like you, who are self-employed but the premiums and the deductibles are so high that you almost never get prevention services -- you've put off going to a doctor until you're really sick because of the out-of-pocket expenses -- let's change some of those incentives so that we get more people getting prevention, more people getting health care to keep them healthy, as opposed to just treating them when they get sick.

And I think that we can come up with a sensible, common sense way that's not disruptive, that still has room for insurance companies and the private sector, but that does not put people in the position where they are potentially bankrupt every time they get sick.

Now, how this debate is going to evolve over the next eight weeks -- I'm very open-minded. And if people can show me, here's a good idea and here's how we can get it done and it's not something I've thought of -- I'm happy to steal people's ideas. (Laughter.) I'm not ideologically driven one way or another about it. (Applause.)

The one thing that I do think is critically important, though, is for self-employed people -- because there are a lot of self-employed people here and a lot of small business people -- they don't have the ability to pool their health insurance risk. And what that means is part of the reason that -- typically if you work for a big company, you get a better deal on health insurance than if you're just working for a small company is because there's a bigger pool. And that means that -- each of us have a certain risk of getting sick, but if that's spread around, everybody's premiums can be lowered because the total risk for everybody is somewhat lower.

If you're self-employed, you don't have access to that same pool. And part of what we have to do -- and that's where a public plan potentially comes in, or at least some mechanism to allow you to join a big pool. That will help drive down your costs immediately: your out-of-pocket costs for premiums, lower your deductibles. And what I'd like to see, as I said, is that every plan includes not only prohibitions against discriminating against people with pre-existing conditions, but also every plan should have incentives for people to use preventive services and wellness programs so that they can stay healthier.

You are somebody who I think could be directly impacted and directly helped if Congress gets this thing done and gets it on my desk, I hope, by sometime in October of this year. (Applause.)
transcript: http://www.whitehouse.gov/the_press_...Bay-Wisconsin/

video: http://www.youtube.com/watch?v=nvFqT...er_profilepage

Last edited by claymisher; 06-12-2009 at 05:45 PM..
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  #68  
Old 06-12-2009, 05:53 PM
Terrye Terrye is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

claymisher:

I think the plan is a <a href="http://hotair.com/archives/2009/06/12/video-the-public-plan-deception/">Trojan Horse</a>. I don't have to read minds. I have been watching Obama evade, lie, flip flop, and revise his policies for months now. I just do not believe a word the man says.

Now if his fan club wants to continue to believe everything he says, fine, but I think he will bankrupt the country. And when he does, guys like you will blame Bush.
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Old 06-12-2009, 06:01 PM
AemJeff AemJeff is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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And when he does, guys like you will blame Bush.
Damn right. It's Bush's fault.
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Old 06-12-2009, 07:35 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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claymisher:

I think the plan is a <a href="http://hotair.com/archives/2009/06/12/video-the-public-plan-deception/">Trojan Horse</a>. I don't have to read minds. I have been watching Obama evade, lie, flip flop, and revise his policies for months now. I just do not believe a word the man says.

Now if his fan club wants to continue to believe everything he says, fine, but I think he will bankrupt the country. And when he does, guys like you will blame Bush.
It's funny that you mention that, because I've been reading between the lines of your posts, and I've concluded you're a kitten rapist. Go ahead and deny it, but the evidence is all there.

Seriously, what's Obama's secret plan to nationalize health care? How's he going to get Dorgan, Nelson, Bayh, and Lincoln to vote for that? They won't even get on for the public option, let alone single-payer, let alone nationalization. I'd like to know. If he can pull that off he'd be history's greatest President.
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Old 06-12-2009, 08:04 PM
cognitive madisonian cognitive madisonian is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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It's funny that you mention that, because I've been reading between the lines of your posts, and I've concluded you're a kitten rapist. Go ahead and deny it, but the evidence is all there.

Seriously, what's Obama's secret plan to nationalize health care? How's he going to get Dorgan, Nelson, Bayh, and Lincoln to vote for that? They won't even get on for the public option, let alone single-payer, let alone nationalization. I'd like to know. If he can pull that off he'd be history's greatest President.
There is a difference between efficacy in passing legislation and good leadership. Passing national health care will not be hard because he has 59 democrats and Specter to work with; he can lose 8 and still pass it with more than 50. Obama has gone on a mad dash toward nationalization of our economy. He's nationalized the automobile industry. He's effectively nationalized the cigarette industry. The banking industry isn't far behind. And health care will be there, too. He's eerily reminiscent of Juan Peron in his political agenda.
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Old 06-12-2009, 08:38 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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There is a difference between efficacy in passing legislation and good leadership. Passing national health care will not be hard because he has 59 democrats and Specter to work with; he can lose 8 and still pass it with more than 50. Obama has gone on a mad dash toward nationalization of our economy. He's nationalized the automobile industry. He's effectively nationalized the cigarette industry. The banking industry isn't far behind. And health care will be there, too. He's eerily reminiscent of Juan Peron in his political agenda.
Fiat bought Chrysler. Ford is hanging in there (good job guys!). We'll see what happens with GM. A bunch of banks went under. The only companies that the government got involved with were companies that bankrupted themselves.

They passed a law to let the Food and Drug Administration regulate tobacco. That's not nationalization. That's just sanity.

You're making this stuff up. Do you think everybody reading this is stupid? Does this kind of exaggeration make you feel good about yourself? What's the point?

In four years when none of your crazy predictions have come true are you got to eat your words? Or just get crazier, and figure that's part of his secret plan too?

Last edited by claymisher; 06-12-2009 at 11:08 PM..
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  #73  
Old 06-12-2009, 08:56 PM
yamascuma yamascuma is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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BTW, how did you come across "The Great Transformation"? I've been interested in economics and anthropology (majored in both in college) for 20 years, and I only just came across it this year. Now all of a sudden I see it cited everywhere!
If I remember correctly, I read it in a graduate course in 19th-century European history. In my opinion, it's a very impressive book, and one that must be kind of confusing to the philosophically libertarian. Which is not to say that it's without its flaws--it's a bit "England-centric"--but the central conclusion (that free markets are created by state action and are not an inherent property of human society) seems as true now as it did then. Which, on the other hand, doesn't mean that libertarians don't often have intelligent perspectives to share or interesting ways of looking at problems. Just not so much in this diavlog.
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Old 06-12-2009, 09:03 PM
rfrobison rfrobison is offline
 
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Default Much heat, little light

I found this conversation pretty unhelpful. Humming and hawing aside, it seems pretty clear that neither Schmitt nor McArdle knows much about the health care system. So in the breach they fall back on their ideological predispositions:

McArdle: Markets are awesome! Competition is awesome! Profits are Awesome!

Schmitt: Government is wonderful! Medicare is a government program (and therefore wonderful)!

I know much less than either of these two about health care or how to fix it. What I'd rather see is two academics, say one who has studied the insurance markets, and another who has done cross-country comparisons on health care spending and outcomes, in order to suggest how the system might be improved in the U.S.

As an aside, one thing The Economist mentions frequently that Democrats won't touch, despite their invoking of the cost-control mantra, is the way in which the medical malpractice system drives up costs. Doctors have a huge incentive to perform every conceivable test and procedure for any conceivable condition, no matter how unlikely, for fear that they will be sued. Lawyers, in turn, have limitless motivation to file suit on highly dubious grounds. This is a huge contributing factor to rising health care costs, but the Democrats won't touch tort reform because half their campaign contributions come from trial lawyers.

Any serious reform of the health care system will also have to make a stab at tort reform as well. The minute I hear a Democratic policy maker admit that, I'd be happy to see the Republicans talk about "public options" for health insurance, or whatever.

Last edited by rfrobison; 06-12-2009 at 09:45 PM.. Reason: Democrats, not "democrats"; inserted "and procedure"
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  #75  
Old 06-12-2009, 09:31 PM
rfrobison rfrobison is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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Also, when Mark said that the government created the culture as it is, and Megan said "it just happened" Mark was right. The same thing is true of capitalism in general, which doesn't come into being without government intervention. C.f. Karl Polanyi, The Great Transformation.
Yama: This is so off topic that I hesitate to bring it up, but I can't resist. The thesis that "government intervention" created capitalism is a bit odd. (Sorry, I haven't read any Polanyi, or if I have it's been so long ago that I've forgotten, so I can't speak to his argument.)

Capitalism depends on many, many factors. If you want to argue that enforcement of property rights, a stable medium of exchange, and maintaining and enforcing peace and tranquility over a long period of time in a broad geographic area are necessary for the development of capitalism, and that this is all you mean by "government intervention," then of course you're right and we have nothing to argue about.

But when we talk about "government intervention" we usually mean governments stepping into markets that already exist to stop something happening that otherwise might (e.g., development of monopolies, or fraud), or to make something happen that would not under ordinary circumstances (e.g., firms voluntarily restricting pollution--the famous "externalities" problem).

Now don't get me wrong. I think governments can and should intervene in these ways to prevent "market failures," but I would argue it is far more accurate to say governments help to create conditions whereby markets "arise naturally." Maybe it's just a question of semantics, but I think the difference in emphasis is important.

Just to rib you a bit: Was government intervention required to create government?

Last edited by rfrobison; 06-12-2009 at 09:40 PM.. Reason: inserted comma
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  #76  
Old 06-12-2009, 11:24 PM
cognitive madisonian cognitive madisonian is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

The government now has the authority to dictate exactly how cigarettes are made. As much as I deplore cigarette smoke, I deplore the government exercising such a gross abuse of authority in interjecting itself into an industry.
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  #77  
Old 06-12-2009, 11:28 PM
claymisher claymisher is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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The government now has the authority to dictate exactly how cigarettes are made. As much as I deplore cigarette smoke, I deplore the government exercising such a gross abuse of authority in interjecting itself into an industry.
Yeah, and potato farmers can't put lead in your food either. Good thing too.
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  #78  
Old 06-12-2009, 11:34 PM
bjkeefe bjkeefe is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

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The government now has the authority to dictate exactly how cigarettes are made. As much as I deplore cigarette smoke, I deplore the government exercising such a gross abuse of authority in interjecting itself into an industry.
As claymisher has already noted, you're both exaggerating and forgetting that virtually everything else sold for human consumption is subject to government regulation.

As I understand the new authority being considered for the FDA, it has almost everything to do with them being able to tell cigarette manufacturers what they may not add to their products, and nothing to do with how they should make them.

By the way, I'm more or less a lifetime smoker, and I still have no problem with this recent move. It's about too late to matter as far as I'm concerned, but I'm all for preventing the tobacco companies from continuing to hook the next generation.
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  #79  
Old 06-13-2009, 12:48 AM
claymisher claymisher is offline
 
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Default Re: Much heat, little light

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Originally Posted by rfrobison View Post

As an aside, one thing The Economist mentions frequently that Democrats won't touch, despite their invoking of the cost-control mantra, is the way in which the medical malpractice system drives up costs. Doctors have a huge incentive to perform every conceivable test and procedure for any conceivable condition, no matter how unlikely, for fear that they will be sued. Lawyers, in turn, have limitless motivation to file suit on highly dubious grounds. This is a huge contributing factor to rising health care costs, but the Democrats won't touch tort reform because half their campaign contributions come from trial lawyers.
Wait, isn't that how the is market suppose to work? The doctors have the incentive to do a good job so they don't get sued. And judges sort it out in the end. Isn't that what libertarians always want?
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  #80  
Old 06-13-2009, 12:56 AM
x9#z6 x9#z6 is offline
 
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Default Re: Health Care Showdown (Mark Schmitt & Megan McArdle)

Megan fails to consider other contributing factors to health care costs. We pay insurance companies and MD's way more then other countries. Why?

I thought libertarians despised unions and like it when companies can negotiate down workers salaries. Well, imagine the health care system as a big company with the insurance and MD folks as their workfroce. In order to make this business leaner and meaner we are just going to have to negotiate down the overbloated salaries of some of its workers. Either that or the company goes bust and then we'll all be out of a job. Now that would suck!
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